Pharmacology Flashcards
Drug class of metformin
Biguanides
Aparaclonidine drug class
Alpha-2 agonist
Weak alpha-1 agonist
What does 10% cocaine drops do to Horner’s pupils?
Dilation of the normal pupil (because lack of NE due to lesion in sympathetic fibers)
MOA of cocaine
Indirect adrenergic agonist
Block the re-uptake of NE by sympathetic nerve ends, leading to increase in sympathetic activity—> mydriasis, sweating, tachycardia
Side effects of topical antihistamines/mast cell stabilizers
- Stinging upon installation
- headaches
- adverse taste
Drug that can cause floppy iris syndrome?
Flomax (tamsulosin)
* treatment for benign prostatic hyperplasia
* alpha-blocker
Amitriptyline
tx?
class?
MOA?
adverse effects
Tx: depression
Tricyclic antidepressant
Blocks reuptake of serotonin and norepinephrine
Side effects: weight gain, dry mouth, dry eyes, drowsiness, blurred vision, dizziness, HA, tachycardia, hypotension, nausea, seizures, photosensitivity
Cosopt
Timolol + dorzolamide
(Beta blocker + CAI)
Combigan
Timolol + brimonidine
(Beta blocker + alpha agonist)
Simbrinza
Brimonidine + brinzolamide
(Alpha agonist + CAI)
What is the generic name of Alrex?
loteprednol 0.2%
Which drug class does Besivance belong to?
4th generation fluoroquinolone
True or false
A compounding pharmacist is needed when a patient requires a medication but is allergic to one of the inactive ingredients
True
They can achieve the same therapeutic effect by preparing meds that includes same dosage of active ingredient without offending agent
Loteprednol is least likely to cause increase in IOP because?
It is ESTER-based
* causes less pressure elevation for given amount of anti-inflammatory effects
*think Ester is better!!!
How long does it take for topical corticosteroids to increase IOP?
~1 month
Which glaucoma medication can cause black/brown pampered conjunctival deposits?
Epinephrine
* topical anti-glaucoma medication
* MOA: decrease IOP by increasing both uveoscleral and trabecular meshwork outflow
Contraindications of topical steroid use
- Epithelial herpes simplex keratitis
- Fungal infections
Contraindications of ORAL steroid use
- Peptic ulcers (stomach lining erosion)
- Osteoporosis (decrease in bone mineral density)
- Psychosis (disconnection from reality)
Which ophthalmic steroids have the highest risk for increasing IOP?
- Durezol (difluprednate)
- predforte
For chronic, mild inflammation management what kind of ophthalmic steroid should be prescribed?
Lotemax (loteprednol)
or
FML (fluorometholone)
What is the only steroid approved for treatment of allergic conjunctivitis?
Alrex (loteprednol 0.2%)
* safest because ESTER based
*treat vernal keratoconjunctivitis
Side effects of Accutane (potent anti-acne med)
- dry eyes
- transient myopic shift
- blurred vision
- decrease in night vision
Which 3 medications are typically used in HAART? (Highly active antiretroviral therapy?
- protease inhibitors
- nucleoside reverse transcriptase inhibitors
- non-nucleoside reverse transcriptase inhibitors
Common side effect experienced by patient on HAART?
Hepatotoxicity
* drug induced liver damage
Topamax drug class
Anticonvulsant
* tx: seizures
Topamax is used to treat what conditions?
*** anticonvulsant
- Epilepsy
- bipolar disorder
- migraines
- depression
Side effects of Topamax?
- Pupillary block
- angle closure
- myopic shift
- occur ~ 2 weeks after initiation of Topamax therapy
Topamax is an anti-convulsant and nerve pain medication, used to prevent seizures
First line treatment for open angle glaucoma and/or ocular HTN
Prostaglandin analog
* lowers IOP the most compared to other classes of glaucoma meds
Side effects of prostaglandins
- Iris color changes
- hyperpigmentation of ocular adnexa (eyelids)
- elongation of eyelashes
Non-selective beta blockers side effects
- alter blood pressure and heart rate
- contraindicated in asthma
Which med is used to tx cardiac arrhythmias, and can develop vortex keratopathy and anterior sub-capsular lens deposits?
Amiodarone
Steroids can induce what type of cataract?
Posterior subcapsular
Med used to treat gout and hyperuricemia
Allopurinol
Patients taking allopurinol have higher risk of developing cataracts if they are?
Elderly patients who take cumulative dose of greater than 400g
Or
Have been taking it for longer than 3 years
Side effects of tetracycline in kids
- short stature
- yellowing of teeth
—————————————
Recall:
* take WITHOUT FOOD
* oral medication used to treat acne rosacea
Which med has been linked to Reye syndrome?
Aspirin
* Reye syndrome is swelling of liver and brain, rare, mostly in kids
* do not give aspirin to children
Which agent reduces the effects of warfarin?
Vitamin K
* warfarin (brand name: Coumadin) anticoagulant
MOA of Warfarin
Inhibits activation of clotting factors that depend on vitamin K synthesis
* anticoagulant
What is the mechanism of action of macrolides?
Binding to the 50S ribosomal subunit, inhibiting protein synthesis
This mechanism makes macrolides effective against certain bacteria.
Name a medication that belongs to the macrolide class.
Erythromycin
Erythromycin is available only in ointment form.
What are the benefits of erythromycin in ocular treatment?
Very little corneal toxicity and good lubricant properties
These properties make it suitable for ocular applications.
What is AzaSite®?
A formulation of azithromycin with high viscosity
Patients should avoid blinking for 5 seconds post-instillation for best absorption.
Why is AzaSite® beneficial for certain patients?
Decreased dosing schedule improves compliance
This makes it easier for patients to adhere to treatment.
What is the mechanism of action of bacitracin?
Inhibits the creation of polysaccharide chains, interfering with cell wall synthesis
* cell wall synthesis inhibitor
This action is specific to gram-positive bacteria.
What type of bacteria is bacitracin effective against?
Gram-positive bacteria
Bacitracin is a cell wall synthesis inhibitor
What enhances the effectiveness of bacitracin?
Pairing with polymyxin B
This combination creates a broad-spectrum antibiotic.
Bacitracin + polymyxin B + neomycin = neosporin
What is the commercial name for the combination of bacitracin and polymyxin B?
Polysporin®
This medication is used for treating various bacterial infections.
What form is bacitracin available in?
Only as an ointment
This limits its application compared to other forms.
What are potential adverse side effects of bacitracin?
Allergic reaction
Patients should be monitored for signs of allergy.
What is the mechanism of action of fluoroquinolones?
Inhibit DNA gyrase
* therefore inhibiting bacterial DNA synthesis
Name one medication that is a fluoroquinolone.
Besivance®
* 4th generation Fluoroquinolone
* broad spectrum
1st gen: ciprofloxacin
2nd gen: ofloxacin
3rd gen: levofloxacin
4th gen: gatifloxacin, moxifloxacin, besifloxacin
True or false
Vancomycin is effective against MRSA infections
True
What special instruction should be given to patients after instilling high viscosity fluoroquinolones?
Inhibit blinking for at least 5 seconds
List two medications that are classified as fluoroquinolones.
- Ciloxan®
- Iquix®
How do aminoglycosides decrease bacterial activity?
By binding to the 30S ribosomal subunit
* tobragent30 = tobramycin and gentamicin
What is Neosporin® a combination of?
- Polymyxin B
- Neomycin
- Bacitracin
Which aminoglycoside has the greatest potential for causing contact dermatitis?
Neomycin
Which aminoglycoside is available as both a solution and an ointment and has the least potential for causing corneal toxicity?
Tobramycin
(30S ribosomal subunit)
Which aminoglycoside is available as both a solution and an ointment?
Gentamicin
* protein synthesis inhibitor works on 30 S ribosomal subunit
What is the mechanism of action of Polymyxin B?
Interferes with the cellular membranes of bacterial pathogens
Polymyxin B is not a stand-alone drug and is often used in combination with other drugs for enhanced efficacy.
Is Polymyxin B effective against gram-positive or gram-negative bacteria?
Gram-negative bacteria
Polymyxin B is specifically effective against gram-negative bacterial pathogens.
What is Polytrim®?
A combination of polymyxin B and trimethoprim
Polytrim® is known for its effectiveness against MRSA.
What is the composition of Polysporin®?
Combination of polymyxin B and bacitracin
Polysporin® is used to treat various infections and is a topical antibiotic.
What are the components of Neosporin®?
Combination of polymyxin B, neomycin, and bacitracin
Neosporin® is a widely used topical antibiotic ointment.
What is the mechanism of action of sulfonamides?
Interfere with the synthesis of folic acid
Sulfonamides are not commonly used in eye care due to sensitivity and allergy issues.
Why are sulfonamides not commonly used in eye care?
Increased patient sensitivity and allergy as well as increased resistance displayed by common bacterial pathogens
These factors contribute to their limited use in treating eye infections.
True or False: Polymyxin B can be used as a stand-alone drug.
False
Polymyxin B is typically used in combination with other antibacterial agents to enhance its efficacy.
Fill in the blank: Polytrim® is effective against _______.
MRSA
MRSA stands for Methicillin-resistant Staphylococcus aureus, a common and difficult-to-treat bacterial infection.
What is a key indicator that an ocular infection is not bacterial?
Absence of ocular discharge
If there is no ocular discharge, chances are the culprit is not bacterial in nature.
What does sectoral injection of the conjunctiva with a clear cornea indicate?
An infectious process is unlikely
If there is sectoral injection of the conjunctiva and the cornea is clear, an infectious process is unlikely.
Which three topical medications offer the best protection against common bacteria causing ocular infections?
- Gentamicin
- Polytrim®
- Besivance®
These three medications lead to the least antibiotic resistance in patients.
What are the two most common bacteria that cause ocular infections?
- Staphylococcus aureus
- Staphylococcus epidermidis
Staphylococcus aureus can be associated with MRSA.
What is the advantage of Vancomycin regarding ocular infections?
Excellent protection against S. aureus and S. epidermidis
Vancomycin must be compounded prior to ocular use.
True or False: Newer antibiotics are always better than older ones.
False
Newer is not necessarily better.
Fill in the blank: If there is no ocular discharge, it is likely that the infection is not _______.
[bacterial]
This indicates that the cause of the ocular issue may be non-bacterial.
What is a potential complication of using topical antibiotics for ocular infections?
Antibiotic resistance
The three medications mentioned lead to the least antibiotic resistance in patients.
Tx for toxoplasmosis
Pyrimethamine and sulfasiazine + corticosteroids
* can be self-limiting and tx is not required
Which antibiotic when used alone has the highest risk of causing pseudomembranous colitis?
Clindamycin
* but if used with sulfadiazine decreased risk of developing
* if patient experiences diarrhea discontinue medication
What unwanted side effects are associated with Pyrimethamine?
Thrombocytopenia, leucopenia, and folate deficiency
Pyrimethamine can lead to a diminished amount of platelets, a decreased number of white blood cells due to bone marrow suppression, and a deficiency of folate.
Why should Pyrimethamine not be used in patients who are immunocompromised?
It can cause bone marrow suppression, leading to decreased white blood cell counts
This increases the risk of infections in immunocompromised patients.
* can cause leucopemia therefore pt needs to get weekly CBC
* pyrimethamine used to treat toxoplasmosis
What should patients taking Pyrimethamine also be prescribed to prevent folate deficiency?
Folic acid mixed with orange juice
This is a preventative measure against the folate deficiency caused by Pyrimethamine.
How often must patients on Pyrimethamine have their blood levels monitored?
Weekly
Patients must have weekly blood draws to monitor red and white blood cell levels and platelet counts.
*tx toxoplasmosis, DO NOT GIVE TO PREGNANT OR BREAST FEEDING WOMEN
Which medication is effective against T. gondii but has significant side effects?
Pyrimethamine
Despite its effectiveness, Pyrimethamine’s side effects can be serious, necessitating careful monitoring.
Fill in the blank: Pyrimethamine can lead to _______ due to its effects on bone marrow.
leucopenia
Leucopenia refers to a decreased number of white blood cells.
*used to treat toxoplasmosis
* pt must get weekly CBC while on medication (platelet count less than 100,000 must reduce dosage)
* do not take vitamins with folic acid
Zymaxid
Generic name?
Drug class?
Dosage to tx corneal abrasions?
- Gatifloxacin
- Fluoroquinolone
- Dosage to tx corneal abrasion: QID with PF AT’s q2h
Isotrentinoin, oral contraceptives, Topamax, and diuretics can cause what type of refractive shift?
Myopic shift
* myopia from corneal swelling, lens swelling, acc spasm, edema of ciliary body
Zoloft
Drug Class?
MOA?
Tx?
- SSRI: selective serotonin reuptake inhibitor
- Inhibit reuptake of serotonin, kept in synaptic cleft longer and repeatedly stimulates receptors
- serotonin: neurotransmitter contributes to feelings of well-being and happiness
Tx: depression
Zoloft has been FDA approved to treat what conditions?
Major depressive disorder
OCD
PTSD
premenstrual dysphoric disorder
Social anxiety disorder
What is the primary difference in effectiveness between oral NSAIDs and topical NSAIDs?
Oral NSAIDs provide an anti-inflammatory effect while topical NSAIDs are more effective in superficial pain management
What is Acular LS® used for?
Management of seasonal allergic conjunctivitis
*and for post surgical inflammation and pain
- Acular is brand name for ketorolac
Dosage: q.i.d.
What is unique about Acuvail® in terms of its packaging?
Available in single dose preservative-free vials
Ketorolac (NSAID)
Dosage: b.i.d.
What must be done before instilling llevro®?
The bottle must be shaken prior to drop instillation
Dosage: q.d.
* NSAID, used to manage post surgical CME
What type of drug is Nevanac® and how does it work?
A prodrug that is converted to amfenac sodium which actively inhibits cyclooxygenase
Dosage: t.i.d.
What is a notable characteristic of Prolensa®?
Possesses a lower pH which allows for potential increased retention time
Bromfenac (NSAID 4
Dosage: q.d.
What is the dosage for Voltaren®?
QID
* generic: diclofenac
What is the dosage for Bromday®?
q.d.
List some clinical uses of NSAIDs.
- Pre-and post-operative inflammation
- Management or prevention of cystoid macular edema
- Corneal abrasions
- Management of pingueculitis or inflamed pterygia
- Allergic conjunctivitis
- Aiding in the adaptation of punctal plugs
What are the clinical uses of NSAIDs?
Pain management secondary to foreign body removal, pain management associated with stromal puncture, post-PKP management
PKP stands for penetrating keratoplasty, a type of corneal transplant surgery.
What is a potential adverse side effect of NSAIDs related to the cornea?
Corneal toxicity and corneal melt
Corneal toxicity refers to damage to the corneal tissue, while corneal melt describes the degradation of corneal structure.
What is one of the adverse side effects of NSAIDs regarding wound healing?
Delayed wound healing
What sensations may patients experience with NSAID instillation?
Stinging and burning
If the daily dose of hydroxychloroquine does not exceed ____ mg, the risk for maculopathy is low
400 mg
Risk of plaquenil toxicity increases when the daily dose is over ___ mg/kg over a period of ___ years
6.5 mg/kg
5 years
Classic retinal findings of hydroxychloroquine maculopathy on fundus and OCT
- On fundus: bulls eye maculopathy
- On OCT: flying saucer sign
Ritalin, Concerta and Adderall are what type of ADHD drugs?
Psycho-stimulants
* provide a calming effect for patients with ADHD
True or false
Strattera is considered a non-stimulant ADHD medication.
TRUE
* effective as the stimulant medications (Ritalin, adderall and concerta) but lower potential for abuse
Recommended dose of oral prednisone to pt with acute s/s of Bell’s palsy
60 mg per day for 5 days
Then taper by 10mg per day for the next 5 days (total treatment of 10 days)
Recommended dose of oral prednisone to pt with acute s/s of Bell’s palsy
60 mg per day for 5 days
Then taper by 10mg per day for the next 5 days (total treatment of 10 days)
Which drug class has an absolute contraindication to using 10% phenylephrine?
Tricyclic antidepressants (ex: amitriptyline)
* Phenylephrine adversely interacts with TCA, monoamine oxidase inhibitors and alpha blockers
Phenylephrine adversely interacts with what drugs?
- TCA (tricyclic antidepressants)
- monoamine oxidase inhibitors
- alpha adrenergic blockers
What drugs can cause pseudo tumor cerebri?
CATS!
Contraceptives
Accutane (isotrentinoin)
Tetracyclines
Synthroid
What is fluticasone?
A synthetic corticosteroid with potent anti-inflammatory action
Fluticasone is effective in controlling asthmatic complications due to inflammation.
Why is fluticasone effective in asthma?
It has a potent anti-inflammatory action that helps control asthmatic complications
Inflammation is a key factor in the pathogenesis of asthma.
What should patients using Advair® be monitored for?
Intraocular pressure and possible development of cataracts
Regular examinations are necessary for patients using corticosteroids.
What is salmeterol?
A long-acting beta2-adrenergic agonist
Salmeterol is used for bronchodilation in asthma management.
What receptors do beta2-adrenoceptors predominantly affect?
Bronchial smooth muscle
They have little association with the heart.
What effect does salmeterol have on cyclic AMP levels?
It increases the levels of circulating cyclic AMP in the bloodstream
This leads to relaxation of bronchial smooth muscle.
What is the result of increased cyclic AMP due to salmeterol?
Relaxation of bronchial smooth muscle and inhibition of hypersensitivity mediators
This is particularly effective in preventing bronchoconstriction.
Which TB drug causes orange/pink tears?
Rifampin
True or false
Prostaglandins for IOP treatment are contraindicated in pts with Hx of Herpes simplex infection
True
Wellbutrin is used to treat?
Depression, seasonal affective disorder
- Anti-depressant
- Drug class: NDRI (norepinephrine and dopamine reuptake inhibitor)
Keflex
MOA?
Tx?
Generic: cephalexin
Cell wall, transpep inhibitor
Dacryocystitis (500mg po every 6 hours for adults)
